**6.4 The role of eating whole plant-based diet in the prevention and management of diabetes mellitus**

Eating a whole plant-based diet involves eating meals composed of plants and removing processed meals, animal and animal products, high salt, sugar and fat. This is because they are all risk factors for non-communicable diseases and diabetes mellitus. These meals are referred to as unhealthy foods because of the negative effects. Consumption of a whole plant-based diet involves eating food rich in fruits, vegetables, and legumes. Fruits, vegetables and legumes are available globally and should be encouraged. Good nutrition is very important in any lifestyle intervention [24]. In whole food plant-based diet, consumption of fruits, legumes, whole grains, including nuts and seeds are emphasized. Also, the consumption of animal products and unhealthy foods such as red and white meat, poultry, fish, eggs, dairy products, refined and processed meal, added sugars and oils are minimized and if possible eliminated from the diet [11]. It has been shown that vegetarians who do not eat any animal product have a low prevalence of diabetes mellitus 2.9% with omnivores having a prevalence of 7.6%. Various data have shown between the consumption of processed meat such as bacon, sausage, and hot dog including consumption of eggs and diabetes mellitus [9]. Counseling patients on nutrition is very important in the management of diabetes mellitus. Every diabetic should always have a counseling session during their follow-up visit which should include diet from food available in the locality. The etiology of a wide range of diseases is linked to diet. One of the fundamental determinants of human health is the amount and type of food consumed [5].

It is very important to balance calorie intake and physical activity as a strategy to maintain an ideal weight and preventing overweight obesity and chronic diseases [3]. To fill up the satiety while consuming low calories, complex carbohydrates with a low glycaemic index should be consumed. Other dietary restrictions such as fasting improve the blood glucose but it should be done under the supervision of a physician preferably an endocrinologist and a diabetologist if available to avoid rebound hyperglycaemia which can lead to non-diabetic ketoacidosis and hyperglycemic hyperosmolar state. Intermittent fasting can be practised by diabetics as it is effective but not strict fasting [11].

Decreased consumption of fruits and vegetables is associated with metabolic syndrome [11]. Nutrition is very important in the practice of lifestyle medicine, various guidelines on nutrition for diabetes mellitus have recommended diets lows in red and processed meat, refined grains, added sugar, food sweetened with sugar and salts and saturated and trans-fat [3].

Lifestyle medicine promotes the eating of whole plant based diet which is one of the pillars of lifestyle medicine. There are various other diets plans that has been found to be beneficial in the management of diabetes mellitus such as the low glycaemic diet, dietary approaches to stop hypertension diet (DASH) and the Mediterranean diet.

In a study conducted by Paula et al. [47], they found out when the DASH diet was combined with walking, the result is a reduction in the ambulatory blood pressure monitoring in hypertensive patients with diabetes mellitus [47].
